Basic Information
| Provider Information | |||||||||
| NPI: | 1649359712 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OVERMAN | ||||||||
| FirstName: | HERMAN | ||||||||
| MiddleName: | BOYD | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | L.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7594 | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278040594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524430808 | ||||||||
| FaxNumber: | 2524519032 | ||||||||
| Practice Location | |||||||||
| Address1: | 505 GREENVILLE BLVD SE | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278586736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523556300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 12/08/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1429 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 199853 | 01 | NC | MEDCOST | OTHER | 0775G | 01 | NC | BCBSNC | OTHER |